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Title: | Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions: Secondary Analysis of a Prospective Clinical Study on Digital Care Programs | Authors: | Janela, Dora Costa, Fabíola Molinos, Maria Moulder, Robert G. Laíns, Jorge Scheer, Justin K. Bento, Virgílio Yanamadala, Vijay Cohen, Steven P. Correia, Fernando Dias |
Keywords: | Digital Therapeutic; Ehealth; Musculoskeletal Conditions; Physical Therapy; Telerehabilitation | Issue Date: | 3-Apr-2023 | Publisher: | VICER Publishing | Project: | SWORD Health | Serial title, monograph or event: | Pain medicine (Malden, Mass.) | Volume: | 24 | Issue: | 4 | Abstract: | Background. Fear-avoidance beliefs (FAB) have been associated with poorer prognosis and decreased adherence to exercise-based treatments in musculoskeletal (MSK) pain. However, the impact of high FAB on adherence and outcomes in upper extremity MSK (UEMSK) pain is poorly explored, particularly through exercise-based digital care programs (DCP). Objective. Assess the adherence levels, clinical outcomes and satisfaction in patients with UEMSK pain and elevated FAB after a fully remote multimodal DCP. Associations between FABQ-PA and clinical outcomes were conducted. Methods. Secondary analysis of an ongoing clinical trial. Participants with UEMSK pain (shoulder, elbow, and wrist/hand) and elevated FAB-physical activity (FABQ-PA 15) were included. Adherence (completion rate, sessions/week, total exercise time) and mean change in clinical outcomes—disability (QuickDASH), numerical pain score, FABQ-PA, anxiety (GAD-7), and depression (PHQ-9)—between baseline and end-of-program were assessed. Associations between FABQ-PA and clinical outcomes were conducted. Results. 520 participants were included, with mean baseline FABQ-PA of 18.02 (SD 2.77). Patients performed on average 29.3 exercise sessions (2.8 sessions/week), totalizing 338.2 exercise minutes. Mean satisfaction was 8.5/10 (SD 1.7). Significant improvements were observed in all clinical outcomes. Higher baseline FAB were associated with higher baseline disability (P<.001), and smaller improvements in disability (P<.001) and pain (P¼.001). Higher engagement was associated with greater improvements in FABQ-PA (P¼.043) and pain (P¼0.009). Conclusions. This study provides evidence of the potential benefits of a structured and multimodal home-based DCP in the management of UEMSK pain conditions in patients with elevated FAB in a real-world context. | URI: | https://hdl.handle.net/10316/113555 | ISSN: | 1526-2375 1526-4637 |
DOI: | 10.1093/pm/pnac149 | Rights: | openAccess |
Appears in Collections: | FMUC Medicina - Artigos em Revistas Internacionais |
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File | Description | Size | Format | |
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Fear Avoidance Beliefs in Upper-Extremity Musculoskeletal Pain Conditions.pdf | 1.05 MB | Adobe PDF | View/Open |
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